Osteoarthritis (OA) of the shoulder is a common debilitating condition affecting up to 5% of
the general population and as much as 32% of patients over 60 years of age. Clinically, OA is
diagnosed by a combination of symptoms, such as slow onset of progressively worsening
shoulder pain and stiffness over months to years (often with a history of minor trauma), and
pain with activity. Physical exam may show tenderness and swelling, muscle atrophy, and
decreased range of motion. Adhesive capsulitis (also called "Frozen Shoulder") is another
common shoulder condition, affecting 2-5% of the general population. Frozen shoulder presents
with a similar combination of symptoms, such as inability to sleep on the side of the
affected shoulder, shoulder pain, and pain at extremes of active and passive range of motion.
Despite the ubiquitous nature of these conditions, various non-operative treatment modalities
have been employed in their managements without a clearly superior alternative. The usual
initial treatment strategy for both of these conditions is the same: a trial of conservative
management. Conservative management includes physical therapy, supervised neglect,
over-the-counter pain medications (including NSAIDs, like Advil), oral and intra-articular
corticosteroid use (steroids), hydrodilatation (capsular distension to rupture),
intra-articular hyaluronic acid injections. Despite several years of employing different
modes of treatment, there is no evidence that places one treatment modality over the others,
and patients will often need surgery.
Amniotic fluid's apparent ability to improve blood flow, re-organize collagen, and protect
cartilage makes it theoretically ideal for disorders like osteoarthritis and frozen shoulder.
In recent studies, it has shown efficacy in promoting ligament healing in the knee and
promoting tendon and degenerative joint pain reduction and functional improvement. It has
been useful as a material for cartilage repair when used as a scaffold. Intra-articular
amnion membrane injection may have favorable outcomes in patients with osteoarthritis of the
shoulder or frozen shoulder. To test this hypothesis, intra-articular amnion will be injected
into the shoulders of 20 patients with moderate to severe osteoarthritis and 20 patients with
frozen shoulder. The hypothesis is that improvement in short-term outcomes (pain, function,
and range of motion) will be identified following amnion injection in these patients. The
goal of this study is to lead to larger randomized controlled trials evaluating amnion
against current forms of treatment for osteoarthritis.